“None of them noticed that she drifted through her days in a state of detachment and abstraction, functioning as she was expected to but not ever, totally there. None of them noticed but me. I was watching her.”

In Asylum, Patrick McGrath blurs the lines between those who treat mental illness and those who suffer from it. Perhaps, McGrath seems to argue, it’s even a matter of proximity…

Asylum is set at an institution for the criminally insane. It’s 1959 when psychiatrist Max Raphael, a dull, dispassionate, “reserved, rather melancholy” man brings his beautiful wife Stella, the daughter of a disgraced diplomat and his 10-year old son, Charlie from London to a walled asylum. Max is the new deputy superintendent, and the Raphaels take up residence in a large stone house just inside the walls. Max has his job and his patients to attend to, Charlie has school, but Stella doesn’t fit in with the other wives … what sort of life does she have within the confines of this “desolate” place?…

Stella is perhaps a trophy wife for Max, but they’re fundamentally mismatched. She’s bored, lonely, unhappy, sexually frustrated, and drinks too much. While the staff see the inmates as an entirely separate group of people, Stella, already alienated from the other hospital wives, resentful of the absolute power of the medical staff, doesn’t seem to be aware of a clear demarcation. Then she meets inmate Edgar Stark, an enigmatic artist who is restoring an old Victorian conservatory at the end of the Raphaels’ vegetable garden. Stark “functioned at a high level ofintelligence,” but he’s subject to paranoid delusions, and years earlier, during a fit of violent rage, he murdered his wife, decapitated her and mutilated her head.

And if you think you know where this story is going, well you’re right. Even though she’s warned about Stark’s past, Stella heads straight for disaster.

The story is narrated, unreliably, by Dr. Peter Cleave, and we know through Cleave’s quiet, controlled narrative voice that something went horribly wrong with Stella. Interestingly, Cleave’s voice is so quiet, so controlled, that there are times when we forget that he is telling the story, and more importantly, that perhaps, just perhaps, he played a role in the events that took place.

The catastrophic love affair characterized by sexual obsession has been a professional interest of mine for many years now. Such relationships vary widely in duration and intensity but tend to pass through the same stages. Recognition. Identification. Assignation. Structure. Complication. And so on. Stella Raphael’s story is one of the saddest I know. A deeply frustrated woman, she suffered the predictable consequences of a long denial collapsing in the face of sudden overwhelming temptation. And she was a romantic. She translated her experience with Edgar Stark into the stuff of melodrama, she made of it a tale of outcast lovers braving the world’s contempt for the sake of a great passion.

The book isn’t simply the story of what takes place; it’s Dr. Peter Cleave’s narrative placed on top of past events. Here is a tale of illicit wild passion, of Stella growing increasingly out of control with the story told by Cleave’s occasional, very occasional, clinical interpretation. It’s not that Cleave’s interpretation is incorrect, but it is inadequate, and just why his clinical interpretation of events is inadequate adds subtle psychological depths to the story. The way Cleave watches Stella and Stark echoes a behaviorist watching two rats in a laboratory–with one important difference; Cleave is not a disinterested observer, and hints of Cleave’s true feelings are buried deep in his narrative. He was opposed to Max’s employment at the asylum in the first place, and his decisions at vital points in the story bring his neutrality into question. It’s perfectly brilliant that Stella’s story should be told by an observer who is hardly disinterested. Edgar Stark, with his “restless, devious intelligence,” is Cleave’s pet patient, and Cleave, a sexually ambiguous character, is fascinated by Stella. There’s a section in the book when Stella and Stark have “urgent and primitive” sex on the ground. In the next paragraph, time has passed and Cleave questions Stella about her sex life with Stark. Interestingly, and hardly coincidentally, he says “I probed her gently,” a very telling, Freudian choice of words when he questions Stella to get the details. It’s a love triangle of sorts with all the physical passion between Stark and Stella, and Cleave a voyeuristic observer who holds limitless power at the asylum.

And that brings me to the book’s title: Asylum–a word that has more than one meaning–a place of refuge or an institution for the mentally ill. The ending packs a powerful punch with Cleave’s professional reasonableness teetering into creepy obsession.

Aslyum was made into a film. It’s well worth watching ( I just watched it for the second time), and although the plot is fundamentally the same in the book and the film, there are some differences. The book, as usual, is more complex and subtle. Peter Cleave is a much more invisible character in the book than in the film whereas Stella is much more off the rails.